Chapter 20 - Clinical Corner

One of the attending physicians who see patients on your floor is well known for prescribing very broad-spectrum antibiotics for all of the patients he sees. He has told the patients that it is the quickest and easiest way to get them well.
A. What is wrong with this approach?
B. What would be the best way to prescribe antibiotics?

This question involves the connection between broad-spectrum antibiotics and the development of resistance and opportunistic infection. .
Question A: The overuse of broad-spectrum antibiotics is dangerous because as we have seen in our discussions it can lead to increased development of antibiotic resistance. It also is involved in the development of opportunistic infections due to the destruction of normal microbial flora (superinfections). This can be especially dangerous in a hospital setting where many opportunistic infections can be hard to deal with.
Question B: The most effective way to prescribe antibiotics is to determine the pathogen involved in the infection and select a narrow spectrum antibiotic that will attack that organism and not affect the normal flora. Sadly, this is a difficult approach because of the time and expense involved in identifying the specific pathogen. In today’s world most people don’t want to take the time or have the added expense so they are given broad-spectrum antibiotics instead.

The neighbor that lives next door received a flu shot and then developed a runny nose coupled with sneezing and coughing. She went to see her doctor and he prescribed a regimen of penicillin to be taken for seven days. After three days, she felt better and stopped taking the drugs. She mentions to you that she stopped taking them so if she got sick again she could use the rest of the medicine and would not have to pay to see the doctor and get a new prescription.
A. What should you tell her about her idea of saving what was left of the prescription for the next time she felt sick?
B. Do you think the prescription was appropriate in the circumstances?

This question asks about the proper use of antibiotics and the use of antibiotics for bacterial as opposed to viral infections.
Question A: You should caution here that her idea could be very dangerous. Antibiotics are designed to work at specific doses taken over specific time periods and to interrupt this timeline can foster the development of antibiotic resistance.
Question B: The prescription for penicillin in this case was probably a poor decision. Recall that penicillin is an antibacterial agent but the symptoms she is exhibiting are similar to those seen in viral respiratory infections. In addition, she has just received a flu shot which can in some cases bring on flu like symptoms. Therefore, antibiotics that attack bacteria will probably be useless for this patient.